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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2006.02.021 Byline: David Charytan (a)(b), Laura Mauri (a)(c), Anupam Agarwal (c)(d), Steven Servoss (d), Benjamin Scirica (c), Richard E. Kuntz, (a)(c) Abstract: Dialysis patients have an excessive risk of cardiovascular death after myocardial infarction (MI). Underutilization of cardiac therapies may partially explain this risk, but whether patients on maintenance dialysis have differential rates of coronary angiography or revascularization during admission for MI compared with patients not on dialysis and whether these differences are explained by the presence of comorbid illness were uncertain. Author Affiliation: (a) Division of Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston, MA (b) Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (c) Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (d) Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA Article History: Received 16 September 2005; Accepted 11 February 2006 Article Note: (footnote) This work was supported by NIH grant T32-DK07199-25 and was presented at the American Society of Nephrology, St. Louis, MO, in October 2004.

A trial was conducted to compare the use of vascular brachytherapy with implantation of the sirolimus-eluting stent for the treatment of restenosis occurring within a previously placed bare-metal stent. Results revealed that superior clinical and angiographic outcomes were obtained from the use of sirolimus-eluting stents as compared to treating restenosis within a bare-metal stent with vascular brachytherapy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.09.001 Byline: Neal I. Muni (a)(c), Robert M. Califf (b), Jonette R. Foy (a), Ashley B. Boam (a), Bram D. Zuckerman (a), Richard E. Kuntz (d) Author Affiliation: (a) Center for Devices and Radiological Health, U.S. Food and Drug Administration, Rockville, Md (b) Department of Cardiology, Duke University Medical Center, Durham, NC (c) Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (d) Department of Clinical Biometrics, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass Article History: Received 10 September 2004; Accepted 10 September 2004 Article Note: (footnote) This manuscript represents the professional opinion of the authors and is not an official document, agency, guidance, or policy of the US Government, the Department of Health and Human Services, or the Food and Drug Administration, nor should any official endorsement be inferred.

Stenting with the use of an emboli-protection device is a less invasive revascularization strategy than endarterectomy in carotid-artery disease. The main finding of the randomized trial is that carotid-artery stenting with the use of an emboli-protection device is not inferior to carotid endarter-ectomy in the prevention of stroke, death, or myo-cardial infarction among patients for whom surgery poses an increased risk.

A stent that releases small amounts of the drug sirolimus over a period of time may reduce the chances that a patient's coronary arteries will become blocked again, according to a study of 1,058 patients. Some of these patients had diabetes, small coronary arteries, or more extensive atherosclerosis. Stents are small cylindrical devices that are placed inside arteries to keep the artery open.

Gamma radiation therapy can prevent coronary arteries from becoming blocked again after angioplasty, according to a study of 252 patients. The radiation was delivered by a small radioactive source attached to a wire that was placed inside the artery. Patients with a small cylindrical device called a stent inside the artery were at risk of developing blood clots that could cause a heart attack.

Aspirin and ticlopidine may be the most effective drug combination for preventing blood clotting around a coronary artery stent. Stents are small metal cylinders used to keep clogged arteries open. Researchers randomly assigned 1,653 patients who received a stent to treat coronary artery disease to take aspirin alone, aspirin and warfarin, or aspirin and ticlopidine. All of these drugs are anticoagulants. Those taking aspirin and ticlopidine were least likely to experience blood clotting around the stent but they were about three times more likely to experience bleeding than those who took aspirin alone.

Balloon mitral valvuloplasty may be an effective treatment for mitral stenosis, a narrowing of the opening of the mitral valve in the heart. Balloon mitral valvuloplasty is a procedure that uses a balloon-tipped catheter to open the mitral valve. Among 146 patients with mitral stenosis on whom balloon mitral valvuloplasty was attempted, 136 (93%) were successfully treated. Twenty-four patients (18%) who underwent the procedure suffered a recurrence of symptoms. Ninety-two patients (63%) were alive an average of 38 months after balloon mitral valvuloplasty was attempted. The estimated disease-free survival rate for patients undergoing balloon mitral valvuloplasty was 74% at the end of two years and 51% at the end of five years. Patients with severe heart valve disease or heart disease were less likely to survive to five years.

The aortic valve is a structure in the heart that directs the flow of blood from the left ventricle to the aorta, the major blood vessel that supplies freshly oxygenated blood to the entire body. Stenosis, or narrowing of the aortic valve, may result in regurgitation, or backflow, of blood into the left ventricle. Aortic stenosis can be treated by replacing the aortic valve or by balloon aortic valvuloplasty. In balloon aortic valvuloplasty, a balloon is inserted into the aortic valve and inflated, thereby widening the narrowed area. Although balloon valvuloplasty was shown to be safe and effective in improving circulation, it is associated with a high rate of restenosis, or recurrence of narrowing. In addition, recent studies suggest that aortic valve replacement in some elderly patients with aortic stenosis is associated with a low death rate of less than 10 percent. The factors that predict survival without restenosis following balloon aortic valvuloplasty were assessed in 205 patients. The rate of survival without restenosis was 18 percent over a follow-up period of two years. Factors associated with increased survival included: the left ventricular ejection fraction (percentage of blood emptied from the left ventricle at the end of a contraction) before valvuloplasty; pressures in the left ventricle and aorta during the contraction phase of the heart cycle before valvuloplasty; a decrease in blood pressure within the aortic valve after valvuloplasty; and pulmonary-capillary wedge pressure (a measure of the blood pressure in the left ventricle at the end of the relaxation phase of the heart cycle). The rate of survival without restenosis was estimated to be between 23 and 65 percent at the end of one year, based on three predictive factors: aortic pressure during heart contraction, pulmonary-capillary wedge pressure, and decreased aortic pressure after valvuloplasty. These findings suggest that survival without restenosis after balloon aortic valvuloplasty is associated with factors related to the function of the left heart ventricle. Patients likely to experience long-term survival after balloon aortic valvuloplasty would also be likely to do well after aortic valve replacement. (Consumer Summary produced by Reliance Medical Information, Inc.)